Active NPI
Apollon III Thezine
- General Practice Dentistry
- Dodge Center, MN
National Provider Identifier
1104698240
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D15010
- Practice address
- 406 W Highway St
Dodge Center, MN 55927-9063 - Phone
- (507) 374-6635
- Fax
- (507) 374-2277
- NPI assigned
- Oct 23, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D15010 | MN | Primary |
Addresses
Primary practice location
406 W Highway St
Dodge Center, MN 55927-9063
Mailing address
406 W Highway St
Dodge Center, MN 55927-9063
Phone (507) 374-6635
Other practice location 1
1812 2nd St SW
Rochester, MN 55902-4127
Phone (507) 208-4141
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D15010 | MN | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Crystal Dental Clinic LLC | General Practice | Current | Accepting new patients |
Locations
1812 2nd St SW
Rochester, MN 55902
Phone (507) 208-4141
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1698019200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711670400000",
"number": "1104698240",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "406 W HIGHWAY ST",
"city": "DODGE CENTER",
"state": "MN",
"postal_code": "559279063",
"telephone_number": "507-374-6635",
"fax_number": "507-374-2277"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "406 W HIGHWAY ST",
"city": "DODGE CENTER",
"state": "MN",
"postal_code": "559279063",
"telephone_number": "507-374-6635",
"fax_number": "507-374-2277"
}
],
"practiceLocations": [
{
"address_1": "1812 2nd St SW",
"address_purpose": "LOCATION",
"city": "Rochester",
"state": "MN",
"postal_code": "559024127",
"country_code": "US",
"telephone_number": "507-208-4141",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "THEZINE",
"first_name": "APOLLON III",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-10-23",
"last_updated": "2024-03-29",
"certification_date": "2024-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MN",
"license": "D15010",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dodge Center, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.